Video‐EEG Study of Psychogenic Nonepileptic Seizures: Differential Characteristics in Patients with and without Epilepsy

Abstract

Summary:Purpose: Psychogenic nonepileptic seizures (PNES) are episodes that may resemble epileptic seizures (ES) but are not associated with abnormal electrical discharges in the brain. Video-EEG recording of a typical episode is considered the best diagnostic tool available. PNES are, however, also documented in patients with epilepsy (PNES/ES). The purpose of this study was to assess this comorbid population, focusing on the differences between patients with PNES/ES and patients with PNES alone.Methods: We reviewed 110 PNES episodes, occurring spontaneously or induced by means of suggestion techniques, recorded in our video-EEG laboratory over a period of eight years. We identified two subgroups of patients, consisting of 85 PNES cases and 25 PNES/ES cases, and assessed any differences in their characteristics by reviewing a number of variables (age, sex, clinical features, antiepileptic therapy, age of onset, time to diagnosis, pathological history, and length of follow-up).Results: The comparison between the two subgroups revealed that PNES/ES patients displayed some statistically significant differences when compared with PNES alone patients, i.e., younger age, a higher percentage of spontaneously activated events, a shorter disease duration, a longer time to PNES diagnosis, and a lower percentage lost at follow-up.Conclusions: This study confirms that PNES is a common, though probably underestimated, occurrence in epilepsy services. Our results shed light on some different characteristics between PNES and PNES/ES patients.

Clinical profile of psychogenic non-epileptic seizures in adults: A study of 63 cases

“…In most of the studies, the commonest PNES subtypes were attacks with excessive motor phenomenon (52-77%). [4851–55] In contrast, limp attacks were the most common PNES type (61.9%) seen in our patients; similar to other Indian studies (Lazarus 2003: 59.2%; Dhanraj 2005: 53.3%). [42–44] The reason behind this is not clear; but probably it is the cultural difference and poor emotional support in our patients, especially among the females.…”

“…As expected, more spontaneous events were seen with prolonged monitoring; as reported in 71-96.2% cases within 48 h of video-EEG monitoring in previous studies. [485051]…”

Which patients with epilepsy are at risk for psychogenic nonepileptic seizures (PNES)? A multicenter case–control study

“…Separately, while there was an anticipated female predominance in our cohort with PNES/ES, a feature documented in most functional disorders, the gender matching in the group with ES-only, by design, may have biased such a cohort into ES types more common to females (e.g., cryptogenic localization-related epilepsies) [19] and may have contributed to some of the identified demographic and semiologic differences. The prespecified matching also prevented the examination of potential gender and age differences between groups, as have been reported using consecutive unselected series of patients (e.g., younger age in those with PNES/ES than in those with PNES-only) [20]. Importantly, revealing our hypothesis a priori to all participating investigators may have contributed to a selection bias during matching.…”

The health care burden of patients with epilepsy in the United States: an analysis of a nationwide database over 15 years

“…This increase has occurred despite the relative increases in the specificity of epileptic diagnostic modalities, and the advent of measures such as video-EEG monitoring and personality assessment inventories for ruling out confounding diagnoses, such as psychogenic seizures, that may have falsely increased the perceived health care burden of epilepsy. 13,21 Although the patient burden has increased dramatically, corresponding medical and surgical modalities of treatment have not yielded adequate results in decreased morbidity for patients, especially for epileptic patients who did not achieve disease control through surgical intervention. 14,16,18,19,22 The increase in prevalence described above has also been coupled with an overall increase in admission for epilepsy, as well as an increasing national health care bill as described by Bodenheimer.…”